Individual
TATUM BOURGEOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPC
Contact information
Practice address
345 SINCLAIR ST, GILLETTE, WY 82718-6478
(307) 217-1881
Mailing address
1103 BEAVER DR, GILLETTE, WY 82718-5604
(307) 217-1881
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PPC-1353
WY
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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